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Long-term follow-up of growth in height after successful liver transplantation
P Codoner-Franch1, O Bernard, F Alvarez
1Service d'Hépatologie Pédiatrique, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France.
Insights
Children
Area of Science:
- Pediatric Endocrinology
- Hepatology
- Transplantation Surgery
Background:
- Orthotopic liver transplantation (OLT) is a life-saving procedure for children with end-stage liver disease.
- Concerns exist regarding long-term growth and development post-OLT, impacting psychosocial well-being.
- Monitoring linear growth is crucial for assessing overall health outcomes in pediatric transplant recipients.
Purpose of the Study:
- To quantitatively assess long-term height growth in children following OLT.
- To identify factors influencing growth patterns and outcomes after liver transplantation.
- To evaluate the impact of OLT on pubertal development and reproductive health.
Main Methods:
- Longitudinal follow-up of 119 children who underwent OLT for over 1 year.
- Construction of height curves to track linear growth velocity.
- Analysis of growth patterns in relation to age at transplantation, corticosteroid use, and pre-existing liver disease etiology.
Main Results:
- Initial poor linear growth observed in the first 6 months post-OLT, coinciding with daily corticosteroid use.
- Significant catch-up growth occurred between 6 and 24 months, irrespective of sex.
- Normal pubertal development, secondary sexual characteristics, and menstrual regularity were observed in most patients.
Conclusions:
- Long-term height growth generally improves after OLT in children with chronic liver disease.
- Optimized corticosteroid regimens (low-dose, alternate-day) positively influence growth.
- Younger age at transplantation is a key factor associated with better long-term linear growth outcomes.
Abstract:
Quantitative assessment of growth in height during the long-term follow-up of children who underwent orthotopic liver transplantation was done to allay concerns related to the progress of the children in terms of normal relationships with peers. Height curves were constructed for 119 children who received transplants at Bicêtre and Cochin Hospitals and were followed for more than 1 year. Poor linear growth was observed during the first 6 months after transplantation, during which time children received corticosteroids daily. The onset of catch-up growth was observed between 6 and 24 months after transplantation, and its magnitude did not differ between male and female patients. Both boys and girls underwent a normal pubertal growth spurt and normal development of secondary sexual characteristics. All adolescent girls had regular menstrual cycles, and one delivered a normal infant 6 years after transplantation. Patients who received transplants before the age of 2 years had poor average growth velocity by the third year after transplantation. Linear growth improved in almost all children and was not affected by the cause of the liver disease that existed before the liver transplantation except that fulminant hepatic failure was associated with poor growth. Long-term improvement of growth in height usually is obtained after liver transplantation in most children with chronic liver diseases. The use of low doses of corticosteroids, administered on an alternate-day basis, contributes to this improvement. Young age of the patient, but not the cause of the chronic liver disease, appears to influence the long-term outcome of linear growth.